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Background Palpitations are a common primary care complaint, frequently leading to cardiology referrals. Traditional monitoring methods often fail due to the episodic nature of symptoms. This study evaluates the utility of a portable ECG device for diagnosing arrhythmias during symptomatic episodes at home.Methods In this retrospective study, we analysed over 5,000 ECG tracings from 252 adults using a portable, smartphone-compatible single-lead ECG device. Patients with accessible ECG submissions were included, excluding non-specific device and formal 12-lead ECG submissions. ECG’s were assessed for arrhythmias, and patient demographics were analysed to explore diagnostic outcomes.Results The study included 57.5% females and 42.5% males with a mean age of 48.8 ± 12.7 years. Females exhibited higher ECG transmission rates. The most common findings were normal sinus rhythm (40.5%) and atrial fibrillation (31.6%). ECG monitoring confirmed or ruled out arrhythmias during symptoms, aiding patient reassurance and reducing unnecessary healthcare utilisation ( table 1, figure 1).Conclusions Home ECG devices are effective in managing palpitations by enabling real-time symptom/rhythm correlation. This approach enhances diagnostic accuracy and improves patient outcomes. Specifically, the detection of atrial fibrillation is crucial as it allows for timely intervention with anticoagulants, effectively reducing the risk of stroke-related complications. This capability not only reduces unnecessary healthcare visits but also has profound public health implications by improving stroke prevention strategies. Future research should aim to validate these findings in larger populations and explore the integration of multiple ECG devices to enhance diagnostic versatility and applicabilityAbstract 84 Table 1Abstract 84 Figure 1